Telenursing practice in the care of patients with surgical cancer: a scoping review

Abstract

Objectives

Surgical oncology patients often experience doubts and uncertainties in the preoperative and postoperative periods, which can be addressed remotely through telenursing. Expanding telenursing services could contribute to more comprehensive perioperative care. We conducted a scoping review to characterise these telenursing services, identify their outcome indicators and examine the content of the care delivered.

Design

A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) recommendations.

Data sources

MEDLINE (PubMed), EMBASE, CINAHL, SCOPUS, Web of Science and Virtual Health Library (VHL), with searches performed up to 5 May 2025.

Eligibility criteria for selecting studies

We included studies that implemented telenursing interventions in the preoperative or postoperative period in adult oncology patients.

Data extraction and synthesis

Two independent reviewers used a standardised search to select and extract data from the included studies. Study characteristics were presented descriptively using absolute and relative frequencies, and the content of telenursing interventions was organised into a circular thematic matrix.

Results

A total of 37 studies were included, published between 1996 and 2024, conducted in 12 countries and primarily focused on postoperative telenursing via telephone or video calls. Preoperative care focused on psychosocial support and guidance related to surgical preparation. Postoperative topics included surgical wound care; handling of devices such as drains, ostomy bags and catheters; instructions for returning to work and support groups for financial and social assistance. Outcome indicators were primarily related to care, including levels of anxiety, stress, depression and quality of life.

Conclusions

Oncologic surgical telenursing remains primarily focused on postoperative care and the delivery of personalised support. Reporting on the protocols used, frequency and duration of sessions, nurse training and profiles, integration with in-person care workflows and operational cost data could strengthen the knowledge base for perioperative telenursing in oncology.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This comprehensive research includes an extensive body of literature on perioperative oncology telenursing practices.

• Telenursing is continually evolving, and future publications may offer new avenues for interpretation.

• This review did not assess the methodological quality of the included articles.

Introduction

Cancer diagnosis, treatment and recovery affect various aspects of patients’ daily lives. The magnitude of these challenges underscores the need for comprehensive, detailed and personalised information tailored to each patient’s individual needs.^{1 2} To help address this challenge, telehealth in oncology patients, particularly telenursing, has been increasingly implemented and studied.^{3 4}

Telenursing is a component of telehealth, in which nurses use information and communication technologies to provide remote nursing care and services.⁵ One area where telenursing is applied is oncology, where treatments such as surgery are often required. In this context, care must address patients’ practical, informational, psychological, social and physical needs during the stages of surgical preparation and recovery.^{2 6}

Although progress has been made in leveraging technology to support care delivery, the unmet informational needs of oncology patients highlight the need to improve communication between nurses and patients.^{1 2} The implementation of perioperative telenursing programmes for surgical oncology patients is a viable strategy to overcome geographic barriers and enhance both self-care competencies and the overall quality of life by managing patient needs.^{7 8}

However, there remains a lack of standardised frameworks regarding the structure of these programmes and the types of care provided to surgical oncology patients. This gap hinders the replication of similar programmes and limits the advancement of knowledge in this field. In the absence of evidence-based nursing guidance, programmes may be designed and implemented solely based on individual nurse experiences and tacit knowledge. Moreover, having a standardised structure would facilitate comparisons between different programmes.

Given this context, the guiding research question of this study was, ‘How does perioperative telenursing occur in surgical oncology patients?’ This question was formulated using the PCC framework, where P (population) refers to patients undergoing oncologic surgery, C (concept) refers to telenursing and C (context) refers to the perioperative period. The objective of this scoping review was to identify how perioperative telenursing is practised in oncology, focusing on three key dimensions: to characterise perioperative oncology telenursing services, to identify the outcome indicators used within these services and to describe the content of care delivered through telenursing in this context. For clarification, the perioperative period in this review is defined as comprising the preoperative, intraoperative and postoperative phases. However, as telenursing is only feasible during the preoperative and postoperative stages, this review focuses exclusively on those two time points.

Methods

We published the review protocol, which is available on the Open Science Framework (OSF) through the link: osf.io/hkznf.⁹ This study followed the scoping review methodology guidelines established by the Joanna Briggs Institute (JBI).¹⁰

Search strategy

Seven sources of scientific literature, including both white and grey literature, were searched on 5 May 2025: MEDLINE (PubMed), EMBASE, CINAHL, SCOPUS, Web of Science, the Virtual Health Library (BVS) and Google Scholar. Additionally, the reference lists of included studies were screened for backward citation searching. These sources were selected based on their comprehensive coverage of scientific research relevant to nursing, digital health and oncology. No restrictions were applied regarding year of publication, language or study design. Further methodological details can be found in the published review protocol.⁹

Study selection

Two reviewers independently assessed and selected the studies by screening the title, abstract and full text using Rayyan software.¹¹ Any disagreements between the reviewers were resolved through discussion with a third reviewer.

The included studies met all the inclusion criteria, which were as follows: adult or older patients in the preoperative or postoperative phase of oncological surgery who received telenursing interventions related to the surgical process. In this context, telenursing is defined as any type of contact conducted via the internet or telephone network for voice calls and video calls as well as using apps for messaging or document sharing.

Studies were excluded if they did not provide a description of the clinical or educational content delivered during the telenursing interventions, as well as information regarding the organisation or structure of the service, at minimum the technology used for communication and the timing of the telenursing intervention.

Data extraction

Each reviewer extracted data using a standardised and pre-tested form. The extracted data included the characteristics of the study and the telenursing programme.

Data synthesis

The characteristics of the scientific articles and telenursing programmes were grouped according to thematic similarity and presented descriptively using absolute and percentage statistics. The content of the telenursing interventions was further categorised by timing (preoperative and postoperative) and by the type of information provided to patients (nursing care and guidance/clarification). These contents were visually represented in a circular thematic matrix. This method of organisation emerged after reviewing the articles and selecting the content aligned with the study objectives.

Patient and public involvement

This is a scoping review that does not involve human participants, personal data or identifiable information. Therefore, informed consent was not required.

Results

This review included 37 studies identified through a rigorous selection process, as depicted in figure 1.

Figure 1. Flow diagram of the studies included in the scoping review.

The studies were published between 1996 and 2024, with 70% (n = 26) conducted in the last decade. The most common research design was experimental, representing 70% (n = 26) of the included studies. Almost all studies were published as scientific articles (n = 33, 97%) and were identified through primary database searches. These details are outlined in online supplemental table 1.

The studies were conducted in 12 countries, with Asia representing the continent with the highest number of publications (n = 13, 35%). However, the USA led the research efforts, accounting for the majority of studies (n = 9, 24%). The geographical distribution of these publications is depicted in figure 2.

Figure 2. Choropleth map of published articles distributed by geographic regions.

Among the communication technologies employed in perioperative oncology telenursing services, there was a predominance of telephone calls used in isolation (n = 27; 73%), followed by a smaller use of video calls (n = 2; 5%). In addition, some studies employed combined modalities, such as telephone calls with web chat (n = 2; 5%), telephone calls with eHealth apps (n = 3; 9%), web chat with video calls (n = 1; 3%), and web chat with eHealth apps (n = 2; 5%). These data are illustrated in figure 3 through a Venn diagram, where each circle represents the number of studies using a given technology. The overlaps between circles indicate studies that employed multiple technologies simultaneously, reflecting the diversity of configurations adopted in telenursing practice.

Figure 3. Technologies used for the practice of perioperative oncology telenursing.

The characteristics of perioperative oncology telenursing programmes are summarised in table 1. The studies covered various types of surgeries, which were categorised into seven groups. The most researched surgical specialities were digestive system surgeries (n = 12, 32%), followed by urological surgeries (n = 10, 27%) and breast surgeries (n = 6, 16%).

Table 1. Characteristics of perioperative oncology telenursing services.

Variable	n	%
Surgical speciality
Digestive system	12	32
Urology	10	27
Mastology	6	16
Multiple specialities	4	12
Thoracic surgery	2	5
Gynaecology	2	5
Head and neck surgery	1	3
Perioperative phase of telenursing application
Preoperative	1	3
Postoperative	36	97
Timing of the first telenursing session
Up to 1 week after hospital discharge	27	73
2 weeks after hospital discharge	1	3
4 weeks after hospital discharge	1	3
6 weeks after hospital discharge	1	3
12 weeks after hospital discharge	2	5
At the patient’s discretion	3	8
Not mentioned	2	5
Duration of patient follow-up through telenursing
1–2 weeks	5	14
3–4 weeks	10	27
2–3 months	9	24
4 months or more	12	32
Not mentioned	1	3
Average duration of the telenursing session
0–10 min	5	14
11–20 min	8	22
21–30 min	2	5
31–60 min	2	5
More than 60 min	1	3
Not mentioned	19	51

Regarding the perioperative phase during which telenursing was applied, only one study (3%) focused on the preoperative stage. In contrast, 97% of the research focused on the postoperative phase (n = 36). Most studies initiated telenursing within the first few days after hospital discharge (n = 27, 73%). However, some studies reported the first contact occurring more than 12 weeks postdischarge (n = 2, 5%), while others followed a schedule based on patient preference rather than a predetermined timeline (n = 3, 9%).

Nurses maintained follow-up contact with patients for varying durations, ranging from up to 2 weeks (n = 5, 14%) to more than 4 months (n = 12, 32%). Regarding the duration of each telenursing session, among studies that provided this information (n = 17, 50%), the most common contact time was between 11 and 20 min (n = 8, 22%).

Regarding outcome indicators, they focused on both patient clinical status and the performance of the telenursing service (table 2).

Table 2. Characteristics of the outcome indicators.

Clinical indicators	Telenursing service performance indicators
Signs, symptoms or complications12,27Quality of life1415 17 28 29 36 37 41,44 46 47Knowledge or self-care ability1922 25 30,32 41 45 47 48Anxiety14 28 30 37 42 44 50Depression14 30 37 42Pain28 33 34 50Ability to perform activities of daily living12 13 24 50Mental health status25 44 49Sexuality or sexual function46 50Nutrition36Stress33Sleep quality14Survival37Distress43Emotional suffering24	Satisfaction with the service or the guidance provided1219 20 22 27,35Hospital readmission12 13 44Unmet needs43 46Incident related to the use of communication technology45Patient-initiated remote contact44

Among clinical indicators, most studies have demonstrated a focus on assessing postoperative signs, symptoms or complications.¹²,²⁷ Regarding service performance indicators, patient satisfaction with the telenursing service1219 20 22 27,³⁵ was the most frequently evaluated outcome.

The core components of perioperative oncology care delivered through telenursing were grouped into nursing care and psychosocial support and practical guidance, as illustrated in figure 4.

Figure 4. Matrix of topics that constitute perioperative oncology telenursing practice.

Preoperative care includes psychosocial support, emotional regulation practices and preoperative guidance. In the postoperative phase, studies addressed a range of topics, including recognising concerning signs and symptoms, managing postoperative devices, such as drains and tubes, and providing guidance on returning to work.

Discussion

The literature on perioperative oncology telenursing practice is expanding, and its outcomes can significantly enhance how nursing care and relevant information are provided during the perioperative period. This review highlighted the fact that, while various communication methods exist for interacting with patients, a combination of different tools demonstrates the creativity, adaptability and innovation of telenursing programmes.^{1415 36},³⁸

The predominance of studies focusing on the postoperative period reinforces the gap previously identified in the introduction regarding the scarcity of telenursing interventions during the preoperative phase.³¹ This absence highlights an opportunity to develop programmes that address this initial stage of surgical care, which could contribute to reducing surgery cancellations related to patient factors,³⁹ strengthening physical and emotional preparation and improving the quality of health guidance and adherence to care pathways.^{23 40} Thus, expanding the use of telenursing to the preoperative phase represents not only an advancement in patient care but also a direct response to persistent gaps in the literature.

Regarding the care provided, monitoring and managing concerning postoperative symptoms was a prominent focus in several studies.1417 22 23 28 29 36,^{38 41}

Telephone calls were the most commonly used synchronous communication method among the included studies. Although this modality requires advanced communication skills from the nurse, it is a well-established and widely accepted tool.^{12 22 26 36 46} Other resources, such as video calls, web chats and eHealth applications, were also employed, particularly for delivering educational content, providing feedback on signs and symptoms and offering group-based social support.^{1415 36},³⁸

A significant number of studies aimed to evaluate the effectiveness of telenursing programmes using outcome indicators sensitive to a variety of variables, including postoperative signs, symptoms or complications,¹²,²⁷quality of life,1415 17 28 29 36 37 41,^{44 46 47} knowledge or self-care capacity,^{1922 25 30},32 41 45 47 48satisfaction with the service or the guidance received,1219 20 22 27,³⁵ and hospital readmission rates.^{12 13 44} These findings underscore the importance of identifying both facilitators and barriers to the implementation of telenursing interventions.

Barriers included the absence of internet or phone network coverage; the need to log in to applications; audio loss; difficulty handling digital tools and challenges in understanding diverse self-care instructions, especially among older adults.^{15 16 20 26 45} To overcome such barriers, in some cases, study participants handed the phone over to a family member or caregiver to facilitate communication.¹⁶

Another significant barrier is the time required for telenursing sessions, as nurses can communicate with only one patient at a time.³⁶ Alternatively, some studies suggested using group video calls for specific topics.^{37 45 46} Moreover, the availability of sufficient equipment, space and adequately trained nurses poses an additional challenge. Furthermore, one study reported that telenursing services are not currently priced, meaning the value of nurses’ work is neither officially recognised nor adequately compensated.³⁶

Conversely, using these communication tools, which do not require in-person contact, allowed postoperative oncology patients to express themselves more freely about their sexuality.^{15 36} This discreet form of conversation fostered patient trust and satisfaction.³⁶ Additionally, direct telenursing support facilitated access to critical information, overcoming geographic barriers that are problematic for patients living far from the hospital.¹⁶

The timely delivery of accurate information tailored to the oncology surgical context and focused on preventing complications and promoting health also contributed to the acceptance of telenursing programmes.^{12 19 49} Telenursing provided opportunities for patients to express their emotions, alleviating feelings of isolation and mental distress, thereby reducing psychological suffering.1214 17 22 23 28 29 36,^{38 41}

Based on the telenursing programmes identified, the findings of this review offer relevant implications for clinical practice, institutional management and scientific research. For nursing practice, the results reinforce the importance of the nurse as a key player in ensuring continuity of care after hospital discharge, particularly through communication technologies such as telephone calls, video consultations and digital applications. This role requires the development of specific skills, including remote clinical assessment, active listening and patient-centred health education. In this context, the importance of tailored training programmes focusing on virtual care delivery is highlighted.

For healthcare managers, the findings suggest that investing in structured telenursing programmes may contribute to reducing postoperative complications, optimising hospital length of stay and increasing patient satisfaction. The predominance of sessions lasting between 11 and 20 min, as well as follow-ups extending up to 4 months, also underscores the need for careful planning of human and technological resources aligned with the complexity and care demands involved.

For researchers, this review reinforces the need for studies that more thoroughly describe clinical protocols, patient-centred outcomes, the economic impact of telenursing programmes and training strategies for healthcare professionals. Additionally, multicentre studies exploring diverse geographic and institutional contexts are needed. These data are essential for developing evidence-based guidelines and safely expanding high-quality telenursing in perioperative oncology settings.

It is worth noting that, although methodological quality assessment of the included studies was not conducted, we acknowledge that this may limit the strength of conclusions regarding the effectiveness of the telenursing interventions. Future systematic reviews with critical appraisals are necessary to deepen our understanding of the efficacy of these strategies within the scope of telenursing.

Based on the gaps identified in this review, further research is needed to explore preoperative telenursing interventions, especially those focusing on psychosocial support, reduction of surgical anxiety and clinical preparation of the patient prior to admission. Additionally, studies evaluating the cost-effectiveness of different telenursing modalities (eg, telephone calls, video consultations and mobile applications) are essential to inform institutional decision-making for implementing such strategies. Clinical trials with patient-centred outcomes—such as quality of life, functional recovery time and hospital readmissions—are also recommended, as well as longitudinal studies assessing the long-term impact of remote follow-up. Finally, given the geographical concentration of the included studies, research in low and middle income countries is needed, with a focus on the feasibility, accessibility and equity in the use of telenursing in oncology contexts.

Conclusion

This scoping review provides a comprehensive synthesis of perioperative telenursing in oncology, highlighting its role in symptom monitoring, care delivery and surgical recovery support for patients with cancer. Most studies used telephone calls as the primary communication tool, with fewer incorporating technologies such as web chat or ehealth applications, despite 68% of the studies being conducted in the past decade. This suggests that ongoing technological advancement and the growing familiarity of older adults with digital tools may significantly influence the outcomes of future telenursing interventions. However, the lack of detailed descriptions of telenursing programmes in several studies limits our understanding of the nurse’s role within these interventions.

To strengthen the body of knowledge on perioperative oncology telenursing, it is essential to provide comprehensive data on the service organisation—including human resources, materials and methods. This would enable scientific discussions that move beyond remote communication skills between nurse and patient. It is therefore recommended that future studies explicitly report the protocols used in telenursing, the frequency and duration of consultations, the profile and training of the nurses involved, the integration of telenursing with in-person care routines and cost-related data. Such transparency would support not only cross-study comparability but also the replication of successful models and the development of evidence-based guidelines for the implementation of high-quality oncology telenursing services.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.